“Unexpected stressors can lead to episodes for me so the better I can plan things, the more stable I am,” said Elaina J. Martin, who writes Being Beautifully Bipolar, a blog on Psych Central.
In fact, there’s an entire therapy dedicated to helping individuals with bipolar disorder identify and maintain daily routines. Founded by Ellen Frank and her colleagues at the Western Psychiatric Institute & Clinic at the University of Pittsburgh, Interpersonal and Social Rhythm Therapy (IPSRT) is predicated on the belief that people with bipolar disorder have a disruption in their sleep and circadian rhythms that may, in part, produce their symptoms.
“Sleep routines are especially important for people with bipolar disorder because sleep deprivation is one of the biggest triggers for manic episodes,” according to Sheri Van Dijk, MSW, a psychotherapist who specializes in bipolar disorder.
Creating and maintaining a routine is not easy. Working with a therapist can help tremendously. But there are strategies you can try on your own to carve out a daily routine. Below are several suggestions.
Getting enough sleep.
When establishing your daily structure, sleep plays a prominent role. “[G]oing to sleep and waking up at approximately the same time is extremely important in developing a routine, since this will, in part, determine what your day is going to look like,” Van Dijk said.
Lack of sleep is a trigger for Martin. She’s rarely up past 11 p.m. or before 8 a.m. “That’s a long sleep, but it is what my body needs so that is what I give it.”
Van Dijk, also author of several books on bipolar disorder and dialectical behavior therapy, shared these tips for getting restful sleep.
- Have an end-of-day routine. “Engaging in the same or similar activities at the end of the day will signal your brain that the day is coming to an end and it’s almost time for bed.” For instance, after dinner, Van Dijk relaxes with her dogs and watches her favorite TV show. Then she reads, brushes her teeth and heads to bed. Other relaxing ideas include: taking a hot bath, meditating and saying your prayers, she said.
- Write your worries. If you have trouble getting to sleep because of worry, write a list of your concerns earlier in the evening, Van Dijk said. “Putting things down on paper means you don’t have to remember it, and sometimes makes it easier to let go of.”
- Listen to music. Listening to music with nature sounds or anything without lyrics also can refocus your mind — “without generating more thoughts.”
- Count your breath. This is Van Dijk’s favorite exercise when thoughts stall her sleep. “Focus on your breathing, not necessarily changing it in any way, just observing it; and start to count your breaths: Inhale one, exhale two, inhale three, exhale four, and so on, up to 10.” When your attention wanders, simply return to your breath, and keep repeating the sequence, she said.
- Practice good sleep hygiene. This includes making sure you’re sleeping in a comfortable bed at a comfortable temperature (not too hot or cold); eliminating light, such as ambient light from a computer, cell phone and TV (“this light tricks your brain into thinking it’s still daylight and will prevent deep sleep”); eliminating noise (Van Dijk uses her fan as white noise so she doesn’t hear the sounds outside her bedroom, which may disrupt her sleep); not having a TV in your bedroom (“your unconscious mind is still processing what it hears, even if you’re not aware of it”); and only using your bed for sleep and sex.
It’s also important to have some structured time, such as “having goals, places to be, things to do,” Van Dijk said. Too much unstructured time can lead to ruminating and engaging in activities, such as watching TV for hours, that leave individuals feeling unproductive and unfulfilled, she said. This also “contributes to low self-esteem.”
Work naturally provides structure. But if you work part-time or can’t work because of your illness, fill your days with other activities, she said.
For instance, according to Van Dijk, you might see your psychiatrist and therapist and attend a regular therapy group. You might volunteer your time and schedule outings with friends. You might incorporate physical activities, such as going to the gym, attending a yoga class, taking walks or swimming.
When Martin was writing her memoir about living with mental illness, she’d spend the mornings and afternoons writing. She also cares for her dogs, which she called an important part of her wellness.
“First thing in the morning we have some pets and rubs and scratches, then it’s off to breakfast and the first of many trips into the backyard. Knowing that I have to take care of them – feed them, give them water, let them out and in again – motivates me.”
She talks to her mom — who’s an integral part of her support system — every day. She schedules weekly coffee dates with a friend and sees her therapist every other week (sometimes more often, if she needs it).
“Knowing that I have a time set aside to talk to someone about anything I am dealing with is a relief to me.” She stressed the importance of having regular appointments with a therapist or psychiatrist — “not just in times of crisis.”
Taking medication is an essential part of Martin’s routine. “It’s as second nature as brushing my teeth in the morning and at night.” When she first started taking medication – which includes several pills throughout the day – she used a pillbox to organize what she needed every morning, afternoon and evening. She’d also set alarms on her phone to remind her to take her medication at that time.
Tracking your symptoms.
According to Martin, it’s also helpful to use a mood tracker to monitor your mood, sleeping habits and medication compliance. This is especially important when you’re newly diagnosed, she said, because it helps you identify what causes your episodes.
She uses the eMoods app. It helps people see how sleep affects their mood and energy levels and even sends a monthly report to your psychiatrist (if you like), she said. Your doctors also should have mood charts you can use.
Creating and maintaining a routine takes effort. But it’s a worthwhile and critical part of effectively managing bipolar disorder.